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Omelchenko MA, Zinkevich AS, Vares AY. [Impulsivity and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:83-92. [PMID: 38147387 DOI: 10.17116/jnevro202312312183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To study the phenomenon of impulsivity, its components and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode. MATERIAL AND METHODS Forty-eight male patients (mean age 19.4±2.9 years) with the first depressive episode (ICD-10 F32.1, F32.2) with attenuated positive, negative and/or disorganized symptoms were examined. According to the severity of impulsivity, the patients were divided into the clinical group (n=26) with pathological impulsivity and the comparison group (n=27) without it. The control group consisted of 41 mentally healthy young men, students of higher education of 1-3 courses, (mean age 19.7±1.6 years). HDRS, SOPS, SANS, Barratt Impulsiveness Scale (BIS-11) and Buss Perry Aggression Questionnaire (BPAQ) were used. Statistical analysis was carried out using the Statistica 12 software. RESULTS The differences between the clinical group and the comparison group were determined by the total score of the subscale of general symptoms of SOPS at admission (53 [41.75; 56] and 45.5 [41.75; 51.25], respectively) (U=187.5; p=0.037) and at discharge (28 [19; 37] and 25 [17.75; 29.25] points respectively) (U=166.5; p=0.012), according to the total HDRS score at admission (35 [31; 38] and 29 [26; 34.25]) (U=191.0; p=0.046). In the clinical group, the motor component of impulsivity and the factor of general impulsivity on the BIS-11 correlated with the severity of aggression on the BPAQ (r=0.395, p<0.05 and r=0.635, p<0.05, respectively). Significant differences were revealed in the clinical group depending on the presence of negative symptoms on the corresponding SOPS subscale according to the total BPAQ score (p=0.01). Correlation analysis showed numerous connections: positive between the total aggressiveness score and the duration of depression (p<0.05), negative between the factors of self-control, consistency, attention, and total scores on the SANS and SOPS (p<0.05). CONCLUSION We identify the differences in the structure of impulsivity in patients at risk of developing schizophrenia at the stage of remission after the first depressive state, the comparison group and the control group, as well as the relationship of impulsivity factors with individual clusters of psychopathological disorders.
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Affiliation(s)
| | | | - A Y Vares
- Lomonosov Moscow State Univesity, Moscow, Russia
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Effectiveness of Artificial Intelligence Methods in Personalized Aggression Risk Prediction within Inpatient Psychiatric Treatment Settings—A Systematic Review. J Pers Med 2022; 12:jpm12091470. [PMID: 36143255 PMCID: PMC9501805 DOI: 10.3390/jpm12091470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/12/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
Aggression risk assessments are vital to prevent injuries and morbidities amongst patients and staff in psychiatric settings. More recent studies have harnessed artificial intelligence (AI) methods such as machine learning algorithms to determine factors associated with aggression in psychiatric treatment settings. In this review, using Cooper’s five-stage review framework, we aimed to evaluate the: (1) predictive accuracy, and (2) clinical variables associated with AI-based aggression risk prediction amongst psychiatric inpatients. Databases including PubMed, Cochrane, Scopus, PsycINFO, CINAHL were searched for relevant articles until April 2022. The eight included studies were independently evaluated using critical appraisal tools for systematic review developed by Joanna Briggs Institute. Most of the studies (87.5%) examined health records in predicting aggression and reported acceptable to excellent accuracy with specific machine learning algorithms employed (area under curve range 0.75–0.87). No particular machine learning algorithm outperformed the others consistently across studies (area under curve range 0.61–0.87). Relevant factors identified with aggression related to demographic and social profile, past aggression, forensic history, other psychiatric history, psychopathology, challenging behaviors and management domains. The limited extant studies have highlighted a potential role for the use of AI methods to clarify factors associated with aggression in psychiatric inpatient treatment settings.
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3
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Long Y, Tong X, Awad M, Xi S, Yu Y. Violence, runaway, and suicide attempts among people living with schizophrenia in China: Prevalence and correlates. PeerJ 2022; 10:e13033. [PMID: 35251789 PMCID: PMC8896021 DOI: 10.7717/peerj.13033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND People living with schizophrenia are at higher risk of disruptive behaviors, including violence, running away from home, and suicide attempts, which often co-occur and are highly correlated, yet seldom studied together. The current study investigated the frequency and correlates of disruptive behaviors among a Chinese community sample of individuals living with schizophrenia. METHODS A cross-sectional study was conducted among 400 individuals living with schizophrenia from 12 communities. Data about disruptive behaviors in the past 2 months was collected using self-designed questionnaires. Clinical characteristics including psychiatric symptoms, depression, anxiety, disability, and functioning were collected by internationally standardized assessment instruments. RESULTS About one-fifth (21%) of the subjects had experienced at least one form of disruptive behavior in the past 2 months. Violence was the most commonly reported (17.25%), which included damaging property (15%) and physical violence toward others (7.5%); followed by running away (6.5%), and suicide attempts (4%). Logistic regression analysis suggested that medication non-adherence (OR = 4.96, 95% CI [1.79-13.72]), involuntary hospital admission (OR = 5.35, 95% CI [2.06-13.87]), depression (OR = 2.34, 95% CI [1.07-5.10]), and lower social functioning (OR = 0.97, 95% CI [0.93-0.99]) were independently associated with a higher risk of disruptive behaviors. CONCLUSIONS The overlap among three forms of disruptive behaviors warrants them to be assessed and studied together in clinical, research, and policy fields. The significant association between disruptive behaviors with medication non-adherence, involuntary admission, depression, and lower social functioning indicates the need for integrated, targeted, and needs-based intervention programs to be developed for the prevention and treatment of these disruptive behaviors.
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Affiliation(s)
- Yixiang Long
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoliang Tong
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Michael Awad
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Shijun Xi
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yu Yu
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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4
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Suicidal ideation in first-episode psychosis: Considerations for depression, positive symptoms, clinical insight, and cognition. Schizophr Res 2021; 228:298-304. [PMID: 33493778 PMCID: PMC7987901 DOI: 10.1016/j.schres.2020.12.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/05/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for individuals with psychosis. Although factors influencing suicide risk have been studied in schizophrenia, far less is known about factors that protect against or trigger increased risk during early-stage and first episode of psychosis. This study examined whether depression, psychotic symptoms, clinical insight, and cognition were associated with suicide ideation among individuals with first-episode psychosis. METHODS Data were obtained from the Recovery After an Initial Schizophrenia Episode (RAISE) project. Participants (n = 404) included adults between ages 15 and 40 in a first episode of psychosis. Measurement included the Positive and Negative Syndrome Scale, Brief Assessment of Cognition in Schizophrenia, and Calgary Depression Scale for Schizophrenia. A logistic regression model evaluated clinical and cognitive variables as predictors of suicidal ideation. RESULTS Greater positive symptoms (OR = 1.085, p < .01) and depression (OR = 1.258, p < .001) were associated with increased likelihood of experiencing suicidal ideation during the RAISE project. Meanwhile, stronger working memory (OR = 0.922, p < .05) and impaired clinical insight (OR = 0.734, p < .05) were associated with a decreased likelihood of experiencing suicidal ideation. CONCLUSION The likelihood of experiencing suicidal ideation was significantly increased when positive and depressive symptoms were present, and significantly decreased when clinical insight was poorer and working memory stronger. These findings have important implications for the role of cognition and insight in risk for suicide ideation in early-stage psychosis, which may aid in improving the prediction of suicide behaviors and inform clinical decision-making over the course of the illness.
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5
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Moreno-Calvete MC, Ballesteros-Rodriguez FJ. Non-pharmacological strategies for self-directed and interpersonal violence in people with severe mental illness: a rapid overview of systematic reviews. BMJ Open 2021; 11:e043576. [PMID: 33431494 PMCID: PMC7802727 DOI: 10.1136/bmjopen-2020-043576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/09/2020] [Accepted: 12/09/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Self-directed and interpersonal violence among people with severe mental illness has become a health priority. Though non-pharmacological interventions have been investigated, to our knowledge, no summary of all systematic reviews on this topic has been reported. We will conduct a rapid overview of reviews to synthesise evidence available by identifying systematic reviews on non-pharmacological interventions for self-directed or interpersonal violence in people with severe mental illness. METHODS AND ANALYSIS This is a protocol for a rapid overview of reviews. The overview will include any systematic reviews (with or without meta-analyses) of randomised controlled trials (RCTs) or cluster RCTs that examine the effect of non-pharmacological interventions on self-directed or interpersonal violence in people with severe mental illness. This protocol applies the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols, the criteria for conducting overviews of reviews in the Cochrane Handbook of Systematic Reviews of Interventions and the criteria for the Cochrane Rapid Reviews. To identify studies, a search will be performed in the following databases: PubMed, EMBASE, PsycINFO, CINAHL, LILACS, SciELO, Web of Science, Scopus, ProQuest, the Cochrane Database of Systematic Reviews through the Cochrane Library and the Epistemonikos database of systematic reviews. The searches date from inception to September 2020. The study selection process will be described using a PRISMA flow diagram, we will assess the quality of evidence in systematic reviews included and the quality of the systematic reviews themselves and the main results will be summarised in categories to provide a map of the evidence available. ETHICS AND DISSEMINATION No patients or other participants will be involved in this study. The results will be presented at mental health conferences and for publication in a peer-reviewed journal. REGISTRATION DETAILS The protocol was registered on the Open Science Framework (https://osf.io/myzd9/).
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Affiliation(s)
| | - Francisco Javier Ballesteros-Rodriguez
- Department of Neuroscience, Biocruces Bizkaia Health Research Institute, CIBER Salud Mental (CIBERSAM), University of the Basque Country UPV/EHU, Leioa, Biscay, Spain
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6
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Sánchez-Sansegundo M, Portilla-Tamarit I, Rubio-Aparicio M, Albaladejo-Blazquez N, Ruiz-Robledillo N, Ferrer-Cascales R, Zaragoza-Martà A. Neurocognitive Functioning and Suicidal Behavior in Violent Offenders with Schizophrenia Spectrum Disorders. Diagnostics (Basel) 2020; 10:diagnostics10121091. [PMID: 33333732 PMCID: PMC7765245 DOI: 10.3390/diagnostics10121091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/12/2020] [Accepted: 12/13/2020] [Indexed: 12/20/2022] Open
Abstract
Suicide is one of the main premature causes of death in patients with schizophrenia. However, little is known about the relationship between neurocognitive functioning and suicidality in violent offenders with schizophrenia who have been sentenced to psychiatric treatment after committing violent crimes. We examined the neurocognitive functioning of a sample of 61 violent offenders, most of them murderers with schizophrenia who were classified as suicide attempters (n = 26) and non-attempters (n = 35). We compared the neurocognitive functioning of both groups using a neuropsychological battery. Suicide attempters showed similar performance to non-attempters in a neuropsychological test across all domains of cognitive functioning, memory, attention, verbal fluency, and executive functioning. However, after controlling for demographic and clinical variables, suicide attempters performed better than non-attempters in two planning-related tasks: the Tower of London (p < 0.01) and the Zoo Map (p < 0.01). Suicide attempters were also characterized as having more family histories of suicidality and as displaying more depressive symptoms and negative symptoms of psychopathology on the Positive and Negative Syndrome Scale (PANSS) scale. These results suggest that suicide attempters have a greater ability to formulate plans and initiate goals directed at making a suicide attempt.
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Affiliation(s)
- Miriam Sánchez-Sansegundo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (I.P.-T.); (M.R.-A.); (N.A.-B.); (N.R.-R.)
| | - Irene Portilla-Tamarit
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (I.P.-T.); (M.R.-A.); (N.A.-B.); (N.R.-R.)
| | - MarÃa Rubio-Aparicio
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (I.P.-T.); (M.R.-A.); (N.A.-B.); (N.R.-R.)
| | - Natalia Albaladejo-Blazquez
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (I.P.-T.); (M.R.-A.); (N.A.-B.); (N.R.-R.)
| | - Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (I.P.-T.); (M.R.-A.); (N.A.-B.); (N.R.-R.)
| | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (I.P.-T.); (M.R.-A.); (N.A.-B.); (N.R.-R.)
- Correspondence: ; Tel.: +34-00-9659000 (ext. 9420)
| | - Ana Zaragoza-MartÃ
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
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7
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Buchanan A, Sint K, Stefanovics E, Rosenheck R. An 18-month longitudinal study of suicidality in patients diagnosed with schizophrenia. Schizophr Res 2020; 224:102-107. [PMID: 33046335 DOI: 10.1016/j.schres.2020.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Suicide kills over 30,000 people annually in the US. Schizophrenia increases the risk, even in psychiatric populations. Identifying high-risk groups within this patient population is central to suicide prevention. We tested the effects of known and putative risk factors for suicide in a clinically recognizable population with symptoms of schizophrenia and unstable illness. METHODS We studied 1439 subjects with schizophrenia participating in the NIMH-funded Clinical Antipsychotic Treatment for Intervention Effectiveness (CATIE) trial and followed for 18Â months. The dependent variable was moderate to severe self-reported suicidal thinking and self-reported suicide attempts. The independent variables comprised potential risk factors for suicidality including measures of clinical change during follow-up. Proportional hazards models of time to first suicidality generated bivariate and multivariate hazard ratios (HRs). RESULTS Altogether 96 patients (7.6%) experienced moderate to severe suicidality in the course of 18Â months. Multivariate analyses showed that baseline moderate or severe suicidality was the strongest correlate of subsequent moderate or severe suicidality (HR 5.1). An increase in a subject's depression score during follow-up was also independently and strongly associated with suicidality (HR 3.5). A change in psychotic symptoms was not. CONCLUSIONS Depression and despair may be more important risk factors for suicidality among people with schizophrenia than psychotic decompensation. Strategies for prevention that seek to identify groups at high risk of suicide should focus on these variables, as well as the effect of prior suicidality.
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Affiliation(s)
- Alec Buchanan
- Law and Psychiatry Division, Department of Psychiatry, Yale University School of Medicine, United States of America; VA Connecticut Health Care System, 950 Campbell Ave, West Haven, CT 06516, United States of America.
| | - Kyaw Sint
- VA New England Mental Illness, Research, Education and Clinical Center, VA Connecticut Health Care System, 950 Campbell Ave., Building 35, West Haven, CT 06516, United States of America
| | - Elina Stefanovics
- VA New England Mental Illness, Research, Education and Clinical Center, VA Connecticut Health Care System, 950 Campbell Ave., Building 35, West Haven, CT 06516, United States of America; Department of Psychiatry, Yale University School of Medicine, United States of America
| | - Robert Rosenheck
- VA New England Mental Illness, Research, Education and Clinical Center, VA Connecticut Health Care System, 950 Campbell Ave., Building 35, West Haven, CT 06516, United States of America; Child Study Center, Yale University School of Medicine, United States of America
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8
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Fochtmann LJ, Medicus J, Hong SH. Performance in Practice: Practice Assessment Tool for the Care of Patients With Schizophrenia. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:402-423. [PMID: 33343252 PMCID: PMC7725154 DOI: 10.1176/appi.focus.20200034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Schizophrenia is associated with significant health, social, occupational, and economic burdens, including increased mortality. Despite extensive and robust research on the treatment of individuals with schizophrenia, many individuals with the illness do not currently receive evidence-based pharmacological and nonpharmacological treatments. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition, aims to enhance knowledge and increase the appropriate use of interventions for schizophrenia, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with schizophrenia. This practice assessment activity can also be used in partial fulfillment of Continuing Medical Education and Maintenance of Certification, part IV, requirements, which can also satisfy requirements for the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System program.
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Affiliation(s)
- Laura J Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Jennifer Medicus
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Seung-Hee Hong
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
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9
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Moreno-Calvete MC, Ruiz-Ibañez I, Uriarte-Uriarte JJ. Scoping review protocol on non-pharmacological interventions for interpersonal and self-directed violence in adults with severe mental illness. BMJ Open 2020; 10:e037006. [PMID: 32928853 PMCID: PMC7488835 DOI: 10.1136/bmjopen-2020-037006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Violence committed by people with mental illness has implications for mental health policy and clinical practice. Several strategies to reduce the risk of aggressive and violent behaviour have been proposed, and these include non-pharmacological interventions. There is, however, a need to identify which of these interventions are effective, and as a first step, we will conduct a scoping review to identify non-pharmacological interventions for self-directed or interpersonal violence in adults with severe mental illness across different conditions and settings. METHODS AND ANALYSIS This is a scoping review protocol. The review will include any randomised controlled trials (RCTs) and cluster RCTs that assess the efficacy of interventions on self-directed or interpersonal violence with no restrictions on the control treatment in people with severe mental illness in any setting. No restrictions will be applied in terms of language or date of publication. To identify studies, a search will be performed in the following databases: Embase, MEDLINE (via PubMed), PsycINFO, CINAHL, LILACS, SciELO, Cochrane Library, Web of Science, Scopus, ProQuest, Epistemonikos and databases of clinical trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement will be followed for reporting the findings, including the use of a PRISMA flow diagram. A standardised form will be used to extract data from studies. The findings will be classified using conceptual categories that will be specified in detail and a descriptive summary of the main results will be created. Moreover, it will be assessed whether the studies identified have been included in systematic reviews or meta-analyses and the results will be used to generate a conceptual map. ETHICS AND DISSEMINATION No patients or other participants will be involved in this study. We will prepare a manuscript for publication in a peer-reviewed journal and the results will be presented at mental health conferences.
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Affiliation(s)
| | - Ivan Ruiz-Ibañez
- Basque Health Service, Bizkaia Mental Health Network, Assertive Community Treatment (ACT) Team, Buenavista Health Centre, Portugalete, Biscay, Spain
| | - Jose Juan Uriarte-Uriarte
- Biocruces Bizkaia Health Research Institute, Basque Health Service, Bizkaia Mental Health Network, Bilbao, Biscay, Spain
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10
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Ostinelli EG, Zangani C, Solmi M. Clozapine for persistent aggressive behaviour or agitation in people with schizophrenia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Edoardo G Ostinelli
- Università degli Studi di Milano; Department of Health Sciences; Via Antonio di Rudinì 8 Milan Italy 20142
| | - Caroline Zangani
- Università degli Studi di Milano; Department of Health Sciences; Via Antonio di Rudinì 8 Milan Italy 20142
| | - Marco Solmi
- University of Padua; Neurosciences Department; Padova PAdova Italy 35100
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11
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Mayoral-van Son J, Juncal-Ruiz M, Ortiz-GarcÃa de la Foz V, Cantarero-Prieto D, Blázquez-Fernández C, Paz-Zulueta M, Paras-Bravo P, Ayuso-Mateos JL, Crespo-Facorro B. Understanding the direct and indirect costs of a first episode of psychosis program: Insights from PAFIP of Cantabria, Spain, during the first year of intervention. Early Interv Psychiatry 2019; 13:1182-1190. [PMID: 30311416 DOI: 10.1111/eip.12752] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/27/2018] [Accepted: 09/22/2018] [Indexed: 11/29/2022]
Abstract
AIM Early intervention psychiatric services for patients with psychosis aim to limit the most damaging outcomes and reduce the patient's risk of social drift, decreasing illness severity and thus containing healthcare costs. There is a scarcity of studies that focus on first-episode psychosis (FEP), and those few that have been published only looked at direct health costs, but not at indirect costs, which make up the bulk of the budget. Our study aims to explore the short-term (1-year follow-up) economic cost of a FEP Program, including both direct and indirect costs. METHODS Data were collected retrospectively from the clinical records of 157 patients included in the Programa Atención Fases Iniciales de Psicosis, from Marqués de Valdecilla University Hospital, Santander. Our data collection sheet collated data from direct and indirect costs associated with the illness. Data were also extracted from the Cantabria Health Service Records. STATA 15.0 was used for statistical analysis. RESULTS On average, the total costs during the first year were €48 353.51 per patient, with direct healthcare costs being €13 729.47 (28.39%), direct non-medical costs €108.6 (0.22%), and indirect costs €34 515.44 (71.39%). We found that hospitalization costs were higher in males (p = 0.081) and in cannabis users (p = 0.032). The number of relapses increased both, hospitalization and treatment costs (r = 0.40 p = 0.000; r = 0.24 p = 0.067, respectively). CONCLUSIONS Intensive Early Intervention in Psychosis Services may result in cost savings by decreasing hospitalization, premature mortality, disability, unemployment, and legal problems; however, the first year after diagnosis would represent the one with the highest costs.
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Affiliation(s)
- Jacqueline Mayoral-van Son
- Department of Psychiatry, Sierrallana Hospital, Torrelavega, Cantabria, Spain.,School of Medicine, University of Cantabria, Santander, Spain.,Instituto de Investigación Sanitaria Valdecilla. IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red en Salud Mental CIBERSAM, Spain
| | - MarÃa Juncal-Ruiz
- Department of Psychiatry, Sierrallana Hospital, Torrelavega, Cantabria, Spain.,School of Medicine, University of Cantabria, Santander, Spain.,Instituto de Investigación Sanitaria Valdecilla. IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red en Salud Mental CIBERSAM, Spain
| | | | | | | | - MarÃa Paz-Zulueta
- Nursing School, University of Cantabria, IDIVAL, GI Derecho Sanitario y Bioética. GRIDES. Cantabria, Spain
| | - Paula Paras-Bravo
- Nursing School, University of Cantabria, IDIVAL, GI Derecho Sanitario y Bioética. GRIDES. Cantabria, Spain
| | - José L Ayuso-Mateos
- Centro de Investigación Biomédica en Red en Salud Mental CIBERSAM, Spain.,Department Psychiatry, University Hospital La Princesa, Autonomous University of Madrid, Madrid, Spain
| | - Benedicto Crespo-Facorro
- School of Medicine, University of Cantabria, Santander, Spain.,Instituto de Investigación Sanitaria Valdecilla. IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red en Salud Mental CIBERSAM, Spain.,Department of Psychiatry, University Hospital Marqués Valdecilla, Santander, Spain
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12
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Kronström K, Tiiri E, Jokiranta-Olkoniemi E, Kaljonen A, Sourander A. Suicidality among child and adolescent psychiatric inpatients: time trend study comparing 2000 and 2011. Eur Child Adolesc Psychiatry 2019; 28:1223-1230. [PMID: 30741340 PMCID: PMC6751151 DOI: 10.1007/s00787-019-01286-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
Child and adolescent inpatient treatment has faced major changes since the year 2000, including shorter inpatient stays and a greater use of psychotropic drugs. This study explored changes and correlates of suicidal threats and suicide acts among inpatients, by comparing Finnish cross-sectional surveys from 2000 to 2011. A questionnaire that explored the background, diagnosis and treatment characteristics of inpatients was sent to all child and psychiatric wards in Finland. The data collection was carried out on specified days in 2000 and 2011. We received comprehensive data on 504 patients from 64/69 (93%) wards in 2000 and on 412 patients from 75/79 (95%) wards in 2011. The Spectrum of Suicidal Behaviour Scale was used to explore suicidality. The prevalence of suicidality did not change in this nationwide study: suicidal threat rates were 38% in 2000 and 37% in 2011, and suicide attempts in both years were 11%. The prevalence of suicidal acts was higher among girls and teenagers, while low general functioning, defined as Children's Global Assessment Scale scores of under 30, was associated with both suicidal threats and acts. Violent acts were associated with both suicidal threats and acts in 2000, but not in 2011. Despite changes in treatment practices and shorter inpatient stays, the prevalence of suicidality in child and adolescent inpatient treatment remained unchanged in Finland in 2000 and 2011.
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Affiliation(s)
- Kim Kronström
- Department of Adolescent Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.
| | - Elina Tiiri
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Elina Jokiranta-Olkoniemi
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Anne Kaljonen
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
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Fond G, Bulzacka E, Boucekine M, Schürhoff F, Berna F, Godin O, Aouizerate B, Capdevielle D, Chereau I, D'Amato T, Dubertret C, Dubreucq J, Faget C, Leignier S, Lançon C, Mallet J, Misdrahi D, Passerieux C, Rey R, Schandrin A, Urbach M, Vidailhet P, Leboyer M, Boyer L, Llorca PM. Machine learning for predicting psychotic relapse at 2 years in schizophrenia in the national FACE-SZ cohort. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:8-18. [PMID: 30552914 DOI: 10.1016/j.pnpbp.2018.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/27/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Predicting psychotic relapse is one of the major challenges in the daily care of schizophrenia. OBJECTIVES To determine the predictors of psychotic relapse and follow-up withdrawal in a non-selected national sample of stabilized community-dwelling SZ subjects with a machine learning approach. METHODS Participants were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia and received a thorough clinical and cognitive assessment, including recording of current treatment. Relapse was defined by at least one acute psychotic episode of at least 7 days, reported by the patient, her/his relatives or by the treating psychiatrist, within the 2-year follow-up. A classification and regression tree (CART) was used to construct a predictive decision tree of relapse and follow-up withdrawal. RESULTS Overall, 549 patients were evaluated in the expert centers at baseline and 315 (57.4%) (mean age = 32.6 years, 24% female gender) were followed-up at 2 years. On the 315 patients who received a visit at 2 years, 125(39.7%) patients had experienced psychotic relapse at least once within the 2 years of follow-up. High anger (Buss&Perry subscore), high physical aggressiveness (Buss&Perry scale subscore), high lifetime number of hospitalization in psychiatry, low education level, and high positive symptomatology at baseline (PANSS positive subscore) were found to be the best predictors of relapse at 2 years, with a percentage of correct prediction of 63.8%, sensitivity 71.0% and specificity 44.8%. High PANSS excited score, illness duration <2 years, low Buss&Perry hostility score, high CTQ score, low premorbid IQ and low medication adherence (BARS) score were found to be the best predictors of follow-up withdrawal with a percentage of correct prediction of 52.4%, sensitivity 62%, specificity 38.7%. CONCLUSION Machine learning can help constructing predictive score. In the present sample, aggressiveness appears to be a good early warning sign of psychotic relapse and follow-up withdrawal and should be systematically assessed in SZ subjects. The other above-mentioned clinical variables may help clinicians to improve the prediction of psychotic relapse at 2 years.
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Affiliation(s)
- G Fond
- Fondation FondaMental, Créteil, France; Faculté de Médecine - Secteur Timone, Aix-Marseille Univ, d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France.
| | - E Bulzacka
- Fondation FondaMental, Créteil, France; INSERM U955, équipe de psychiatrie translationnelle, Créteil, France, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - M Boucekine
- Faculté de Médecine - Secteur Timone, Aix-Marseille Univ, d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; INSERM U955, équipe de psychiatrie translationnelle, Créteil, France, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - F Berna
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - O Godin
- Fondation FondaMental, Créteil, France; INSERM U955, équipe de psychiatrie translationnelle, Créteil, France, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux F-33076, France; INRA, NutriNeuro, University of Bordeaux, U1286, Bordeaux F-33076, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Hôpital la Colombière, CHRU Montpellier, Service Universitaire de Psychiatrie Adulte, Université Montpellier 1, Montpellier 1061, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; Faculté de Médecine, Université d'Auvergne, CMP B, CHU, EA 7280, Clermont-Ferrand Cedex 69 63003, France
| | - T D'Amato
- Fondation FondaMental, Créteil, France; Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, Bron Cedex 69678, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Faculté de médecine, Louis Mourier Hospital, Université Paris Diderot, Colombes U894, France
| | - J Dubreucq
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, Alpes Isère, Grenoble, France
| | - C Faget
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - S Leignier
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, Alpes Isère, Grenoble, France
| | - C Lançon
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - J Mallet
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Faculté de médecine, Louis Mourier Hospital, Université Paris Diderot, Colombes U894, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux F-33076, France; CNRS UMR 5287-INCIA, France
| | - C Passerieux
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - R Rey
- Fondation FondaMental, Créteil, France; Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, Bron Cedex 69678, France
| | - A Schandrin
- Fondation FondaMental, Créteil, France; Hôpital la Colombière, CHRU Montpellier, Service Universitaire de Psychiatrie Adulte, Université Montpellier 1, Montpellier 1061, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - P Vidailhet
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France; INSERM U955, équipe de psychiatrie translationnelle, Créteil, France, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | | | - L Boyer
- Fondation FondaMental, Créteil, France; Faculté de Médecine - Secteur Timone, Aix-Marseille Univ, d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; Faculté de Médecine, Université d'Auvergne, CMP B, CHU, EA 7280, Clermont-Ferrand Cedex 69 63003, France
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14
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Steeg S, Webb RT, Mok PLH, Pedersen CB, Antonsen S, Kapur N, Carr MJ. Risk of dying unnaturally among people aged 15–35 years who have harmed themselves and inflicted violence on others: a national nested case-control study. LANCET PUBLIC HEALTH 2019; 4:e220-e228. [DOI: 10.1016/s2468-2667(19)30042-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022]
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Bornheimer LA. Suicidal Ideation in First-Episode Psychosis (FEP): Examination of Symptoms of Depression and Psychosis Among Individuals in an Early Phase of Treatment. Suicide Life Threat Behav 2019; 49:423-431. [PMID: 29444349 PMCID: PMC6092261 DOI: 10.1111/sltb.12440] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022]
Abstract
First-episode psychosis (FEP) is a particularly high-risk period for suicide, in which risk elevates by 60% within a first year of treatment as compared to later stages of illness. To date, much of the literature has focused on individuals with a longer duration of psychosis; thus, there is an urgency for research to examine suicide risk among individuals in FEP in the beginning stage of treatment. This study aimed to identify the relationships between demographic characteristics, symptoms of depression, psychosis (particularly positive symptoms of psychosis), and suicidal ideation among individuals in FEP. Secondary data were obtained from National Institute of Mental Health's Early Treatment Program of the Recovery After an Initial Schizophrenia Episode project (NÂ =Â 404). Consistent with prior research, participants who experienced suicidal ideation during the study period reported having a longer duration of untreated psychosis and greater symptoms of depression. Further, positive symptoms of psychosis, namely hallucinations and delusions, were found to increase the odds of experiencing suicidal ideation. Findings point toward the implication that depression and positive symptoms of psychosis relate to the experience of suicidal ideation among individuals with a FEP and should be evaluated for and treated in the early stages of treatment.
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16
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Faay MDM, van Os J. Aggressive Behavior, Hostility, and Associated Care Needs in Patients With Psychotic Disorders: A 6-Year Follow-Up Study. Front Psychiatry 2019; 10:934. [PMID: 31998154 PMCID: PMC6961536 DOI: 10.3389/fpsyt.2019.00934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/25/2019] [Indexed: 01/13/2023] Open
Abstract
Background: Hostility and aggressive behavior in patients with psychotic disorders are associated with demographic and clinical risk factors, as well as with childhood adversity and neglect. Care needs are an essential concept in clinical practice; care needs in the domain of safety for others reflect the actual problem the patient has. Hostility, aggressive behavior, and associated care needs, however, are often studied in retrospect. Method: In a sample of 1,119 patients with non-affective psychotic disorders, who were interviewed three times over a period of 6 years, we calculated the incidence of hostility, self-reported maltreatment to others and care needs associated with safety for other people (safety-to-others). Regression analysis was used to analyze the association between these outcomes and risk factors. The population attributable fraction (PAF) was used to calculate the proportion of the outcome that could potentially be prevented if previous expressions of adverse behavior were eliminated. Results: The yearly incidence of hostility was 2.8%, for safety-to-others 0.8% and for maltreatment this was 1.8%. Safety-to-others was associated with previous hostility and vice versa, but, assuming causality, only 18% of the safety-to-others needs was attributable to previous hostility while 26% was attributable to impulsivity. Hostility, maltreatment and safety-to-others were all associated with number of unmet needs, suicidal ideation and male sex. Hostility and maltreatment, but not safety-to-others, were associated with childhood adversity. Neither safety-to-others, maltreatment nor hostility were associated with premorbid adjustment problems. Conclusion: The incidence of hostility, self-reported aggressive behaviors, and associated care needs is low and linked to childhood adversity. Known risk factors for prevalence also apply to incidence and for care needs associated with safety for other people. Clinical symptoms can index aggressive behaviors years later, providing clinicians with some opportunity for preventing future incidents.
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Affiliation(s)
- Margo D M Faay
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jim van Os
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, United Kingdom
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Brown S, O’Rourke S, Schwannauer M. Risk factors for inpatient violence and self-harm in forensic psychiatry: the role of head injury, schizophrenia and substance misuse. Brain Inj 2018; 33:313-321. [DOI: 10.1080/02699052.2018.1553064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sarah Brown
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Suzanne O’Rourke
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, The State Hospital, Carstairs, UK
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18
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SanSegundo MS, Ferrer-Cascales R, Bellido JH, Bravo MP, Oltra-Cucarella J, Kennedy HG. Prediction of Violence, Suicide Behaviors and Suicide Ideation in a Sample of Institutionalized Offenders With Schizophrenia and Other Psychosis. Front Psychol 2018; 9:1385. [PMID: 30131743 PMCID: PMC6091276 DOI: 10.3389/fpsyg.2018.01385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 07/17/2018] [Indexed: 11/13/2022] Open
Abstract
This study examined the predictive validity of the Spanish version of the Suicide Risk Assessment Manual (S-RAMM) and the Historical-Clinical-Risk Management-20 (HCR-20) in a sample of violent offenders with schizophrenia and other psychosis, who had committed violent crimes and had been sentenced to compulsory psychiatric treatment by the criminal justice system. Patients were prospectively monitored within the institution for 18 months. During the follow-up period, 25% of offenders were involved in any suicidal behavior including acts of self-harm, suicidal ideation and suicide attempts and 34% were physically or verbally violent. The S-RAMM and HCR-20 risk assessment tools were strongly correlated and were able to predict suicidal behavior and violence with a moderate-large effect size (AUCs = 0.81-0.85; AUCs = 0.78-0.80 respectively). Patients scoring above the mean on the S-RAMM (>20-point cut-off) had a five times increased risk of suicide related events (OR = 5.05, 95% CI = 2.6-9.7) and sevenfold risk of violence in the HCR-20 (>21-point cut-off) (OR = 7.13, 95% CI = 2.0-21.2) than those scoring below the mean. Offenders at high risk for suicide and violence had significantly more suicide attempts (p < 0.001) and more prior sentences for violent crimes (p < 0.001). These results support the use of the S-RAMM and HCR-20 for clinical practice by providing evidence of the utility of these measures for predicting risk for suicidal and violent behavior in mentally disordered offenders.
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Affiliation(s)
| | | | - Jesús H. Bellido
- Department of Psychology, Alicante Forensic Psychiatric Hospital, Alicante, Spain
| | - Mar P. Bravo
- Department of Psychiatry, Institute of Legal Medicine, Alicante, Spain
| | | | - Harry G. Kennedy
- Department of Psychiatry, Trinity College, University of Dublin, Dundrum, Ireland
- Central Mental Hospital, Dublin, Ireland
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Locked in and Growing Old: The Psychiatric, Forensic, and Cognitive Correlates of 30 Years of Psychiatric Hospitalization. Am J Geriatr Psychiatry 2018; 26:188-197. [PMID: 29122420 DOI: 10.1016/j.jagp.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE As the number of older adults in the United States continues to grow, the population of older adults with severe mental illness in institutional settings (OASIS) is expected to place a significant demand on healthcare resources. This study presents an update to research regarding the clinical characteristics of OASIS inpatients with histories of extensive hospitalization through the use of a newly developed psychiatric measure: the Clinician-Rated Dimension of Psychosis Symptom Severity. METHODS We investigated an OASIS sample (N = 55) with an average of nearly 30 continuous years of hospitalization at a forensic state psychiatric hospital. RESULTS The average OASIS patient exhibited the most prominent psychiatric symptoms via delusions and negative symptoms, received psychotropic medications at substantially higher doses than recommended therapeutic levels, rarely committed acts of institutional violence (IV), and performed more than two standard deviations below the normative mean on cognitive testing. More severe hallucination symptoms were associated with higher psychotropic medication dosage, and more severe depressive symptoms were associated with more IV incidents. OASIS inpatients performed moderately worse than general psychiatric inpatients in the areas of overall cognition, immediate memory, and delayed memory; older age was associated with poorer language and attention. No psychiatric or cognitive factors predicted IV incidents. CONCLUSION These results highlight the continued importance of understanding the psychiatric, forensic, and cognitive factors associated with aging in an institutional setting and how these factors among OASIS inpatients may vary from general psychiatric inpatients.
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20
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Wigand ME, Lang FU, Reichhardt L, Schulze TG, Walther S, Becker T, Jäger M. Severe clinical events in 100 patients with schizophrenia: a retrospective clinical description using a system-specific psychopathological approach. Nord J Psychiatry 2018; 72:1-8. [PMID: 28846054 DOI: 10.1080/08039488.2017.1368701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Catatonic states and numerous other severe clinical events can complicate the course of schizophrenia. Whether these severe courses are associated with particular system-specific symptom dimensions remain unclear. Aim is to assess the frequency of severe clinical events in a clinical population and to investigate the association of these events with sociodemographic data and system-specific psychopathology, combining qualitative and quantitative data. We performed a comprehensive retrospective description of a well-described and geographically stable sample of 100 patients with schizophrenia or schizoaffective disorder and linked severe clinical events with sociodemographic data at inclusion into the study (as indicators of social functioning) and symptoms at first admission, classified with the Bern Psychopathology Scale (BPS). We found 12 mentions of catatonic stupor or excitement, 45 of suicide attempts, 26 of suicidality, 18 of deliberate self-harm, 18 of self-threatening behaviour other than deliberate self-harm, 34 of violence against other persons, 18 of violence against objects and six of sexual harassment. Disinhibited language on first admission seemed to be a protective factor against suicidality and disinhibited motor behaviour seemed to predict self-threatening and violent behaviour. Catatonia and violence in particular seemed to be socially disabling. This exploratory study showed that the BPS is a promising instrument and might represent a system-specific approach in identifying patients at risk for severe sequelae of schizophrenia. This will have to be tested in future prospective studies.
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Affiliation(s)
- Moritz E Wigand
- a Department of Psychiatry and Psychotherapy II , Ulm University , Günzburg , Germany
| | - Fabian U Lang
- a Department of Psychiatry and Psychotherapy II , Ulm University , Günzburg , Germany.,b Medical Practice for Psychiatry and Psychotherapy Lang , Gersthofen , Germany
| | - Lea Reichhardt
- a Department of Psychiatry and Psychotherapy II , Ulm University , Günzburg , Germany
| | - Thomas G Schulze
- c Institute of Psychiatric Phenomics and Genomics , LMU München , Munich , Germany
| | - Sebastian Walther
- d Translational Research Center , University Hospital of Psychiatry , Bern , Switzerland
| | - Thomas Becker
- a Department of Psychiatry and Psychotherapy II , Ulm University , Günzburg , Germany
| | - Markus Jäger
- a Department of Psychiatry and Psychotherapy II , Ulm University , Günzburg , Germany.,e Department of Psychiatry, Psychosomatic and Psychotherapy , Bezirkskrankenhaus Kempten , Kempten , Germany
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Suicidality is a common and serious feature of anti-N-methyl-D-aspartate receptor encephalitis. J Neurol 2017; 264:2378-2386. [DOI: 10.1007/s00415-017-8626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 01/17/2023]
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22
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Bornheimer LA, Jaccard J. Symptoms of Depression, Positive Symptoms of Psychosis, and Suicidal Ideation Among Adults Diagnosed With Schizophrenia Within the Clinical Antipsychotic Trials of Intervention Effectiveness. Arch Suicide Res 2017; 21:633-645. [PMID: 27552340 PMCID: PMC5784410 DOI: 10.1080/13811118.2016.1224990] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Suicide is among leading causes of death for adults diagnosed with schizophrenia. While symptoms of depression are consistently supported factors involved in suicidal ideation, findings on the role of positive symptoms of psychosis have been mixed with limited understandings of risk. Accordingly, this study aimed to identify the pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), and suicidal ideation. Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n = 1,460). Suicidal ideation and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). The data were analyzed using Structural Equation Modeling (SEM). As symptoms of depression and positive symptoms of psychosis independently increased, on average there were associated increases in suicidal ideation. The present study provides support for the relationship between positive symptoms of psychosis, specifically hallucinations and delusions, and suicidal ideation. Future prospective longitudinal study designs are needed to further increase understandings of the roles that hallucinations, delusions, and additional symptoms of schizophrenia play in both suicidal ideation and attempt to ultimately inform evidence-based interventions aiming to reduce suicidal death.
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Saavedra J, López M, Trigo ME. Association between Violent Crime and Psychosis in Men Serving Prison Terms. THE SPANISH JOURNAL OF PSYCHOLOGY 2017; 20:E30. [PMID: 28651657 DOI: 10.1017/sjp.2017.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Psychosis has been associated with committing violent crimes. However, it has been reported that the association is mediated by toxin consumption, personality disorders, and positive symptoms. This study will examine the relationship between different psychological disorders and sociodemographic variables, and violent crime perpetration in a sample of 472 men serving prison terms in Andalusia, Spain. A correlation-based, retrospective study was conducted and data were analyzed through logistic regression. The sample is representative of the Andalusian prison population, with a 95% level of confidence and .02% precision. Inmates were sampled and diagnosed by expert clinicians using the SCID-I and the IPDE-II. We computed bivariate correlations between the aforementioned variables and perpetration of violent crimes (murder, homicide, attempted murder, and injury) to later apply logistic regression and find adjusted odds ratios. We confirmed the association between diagnosis of functional psychoses and violent crime, with a significant adjusted odds ratio in the last model (OR = 3.71; p = .010). Other significant variables that acted like risk factors include suicide attempts (OR = 2.04; p = .046), having received care at a mental health facility in the year before imprisonment (OR = 3.83; p = .008), and more strongly than the psychosis diagnosis, low level of education (OR = 10.32; p = .029). Toxin consumption and personality disorders were not significant in the final model.
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Affiliation(s)
| | - Marcelino López
- Fundación Pública Andaluza para la Integración de las Personas con Enfermedad Mental (Spain)
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Johnson KL, Desmarais SL, Tueller SJ, Grimm KJ, Swartz MS, Van Dorn RA. A longitudinal analysis of the overlap between violence and victimization among adults with mental illnesses. Psychiatry Res 2016; 246:203-210. [PMID: 27721058 PMCID: PMC5161544 DOI: 10.1016/j.psychres.2016.09.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 09/09/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
Prior research suggests considerable overlap of violence perpetration and victimization among adults with mental illnesses. However, there has been no examination of how the likelihood of being a victim and/or perpetrator of violence may change over time, nor consideration of clinically-relevant factors affecting these transitions. In a pooled sample of adults with mental illnesses (N=3,473) we employed latent transition analysis to: (a) determine prevalence of four violence and victimization classifications (i.e., non-victim/non-perpetrator, victim only, perpetrator only, and victim-perpetrator) over a 6-month period; (b) calculate the likelihood that adults with mental illnesses will remain in or transition between these classifications over time; and (c) assess the effects of recent substance use, psychiatric symptoms, and suicidal behaviors on transitions over time. At each time point, the majority of participants identified as non-victim/non-perpetrators, followed by victim-perpetrators, victims only, and perpetrators only. Analyses also revealed many individuals transitioned between classifications over time. These distinct pathways towards, and away from, violent outcomes were, in part, a function of recent violence and/or victimization, as well as substance use, psychiatric symptoms, and suicidal behaviors. Findings inform the identification of adults with mental illnesses at risk of violence and victimization and highlight points of intervention.
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Affiliation(s)
- Kiersten L. Johnson
- Behavioral and Urban Health Program, RTI International,Author Contact Information: Kiersten L. Johnson, PhD, Behavioral and Urban Health Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, Phone: 919-485-2639,
| | | | | | | | - Marvin S. Swartz
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
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Bhui K, Silva MJ, Topciu RA, Jones E. Pathways to sympathies for violent protest and terrorism. Br J Psychiatry 2016; 209:483-490. [PMID: 27609812 DOI: 10.1192/bjp.bp.116.185173] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Radicalisation is proposed to explain why some individuals begin to support and take part in violent extremism. However, there is little empirical population research to inform prevention, and insufficient attention to the role of psychiatric vulnerabilities. AIMS To test the impact of depressive symptoms, adverse life events and political engagement on sympathies for violent protest and terrorism (SVPT). METHOD A cross-sectional survey of a representative sample of Pakistani and Bangladeshi men and women from two English cities. Weighted, multivariable, logistic regression yielded population estimates of association (odds ratio (OR) and 95% confidence intervals) against a binary outcome of SVPT derived from a three-group solution following cluster analysis. RESULTS Depressive symptoms were associated with a higher risk of SVPT (OR = 2.59, 95% CI 1.59-4.23, P<0.001), but mediated little of the overall effects of life events and political engagement, which were associated with a lower risk of SVPT (death of a close friend: OR = 0.24, 95% CI 0.07-0.74; donating money to a charity: OR = 0.52, 95% CI 0.3-0.9). CONCLUSIONS Independent of SVPT associations with depressive symptoms, some expressions of social connectedness (measured as life events and political engagement) are associated with a lower risk of SVPT.
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Affiliation(s)
- Kamaldeep Bhui
- Kamaldeep Bhui, BSc, MBBS, MSc, MD, FRCPsych, Maria Joao Silva, MSc, Raluca A. Topciu, MD, MA, PhD, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Edgar Jones, MA, PhD, DPhil, King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Joao Silva
- Kamaldeep Bhui, BSc, MBBS, MSc, MD, FRCPsych, Maria Joao Silva, MSc, Raluca A. Topciu, MD, MA, PhD, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Edgar Jones, MA, PhD, DPhil, King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Raluca A Topciu
- Kamaldeep Bhui, BSc, MBBS, MSc, MD, FRCPsych, Maria Joao Silva, MSc, Raluca A. Topciu, MD, MA, PhD, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Edgar Jones, MA, PhD, DPhil, King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Edgar Jones
- Kamaldeep Bhui, BSc, MBBS, MSc, MD, FRCPsych, Maria Joao Silva, MSc, Raluca A. Topciu, MD, MA, PhD, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; Edgar Jones, MA, PhD, DPhil, King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Bornheimer LA. Moderating effects of positive symptoms of psychosis in suicidal ideation among adults diagnosed with schizophrenia. Schizophr Res 2016; 176:364-370. [PMID: 27450776 PMCID: PMC5784415 DOI: 10.1016/j.schres.2016.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Suicide is among the leading causes of death for adults diagnosed with schizophrenia, with risk estimates being over eight folds greater than the general population. While the majority of research to date focuses on the role of symptoms of depression in suicide risk, there is a lack of consensus and understanding of the relationship between positive symptoms of psychosis and both suicidal ideation and attempt. The current study examined pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), hopelessness, and suicidal ideation among a population of adults diagnosed with schizophrenia. METHODS Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n=1460) at baseline. Suicidal ideation, hopelessness, and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). Data were analyzed with Structural Equation Modeling (SEM) using Mplus 7. RESULTS Symptoms of depression, positive symptoms of psychosis, and hopelessness independently predicted suicidal ideation. Hopelessness significantly mediated the relationship between symptoms of depression and suicidal ideation. Lastly, positive symptoms of psychosis were found to moderate the relationship between symptoms of depression and suicidal ideation. CONCLUSIONS The current study provides evidence for the role that positive symptoms of psychosis (specifically hallucinations and delusions) play in suicidal ideation, pointing towards the implication that beyond symptoms of depression, positive symptoms must be evaluated for and treated.
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Affiliation(s)
- Lindsay A Bornheimer
- Brown School of Social Work, Washington University in St. Louis, United States; McSilver Institute for Poverty Policy and Research, New York University, 20 Cooper Square, 2nd Floor, New York, NY 10003, United States.
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Pinna F, Tusconi M, Dessì C, Pittaluga G, Fiorillo A, Carpiniello B. Violence and mental disorders. A retrospective study of people in charge of a community mental health center. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 47:122-128. [PMID: 27180213 DOI: 10.1016/j.ijlp.2016.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Numerous studies conducted in inpatient settings have highlighted how mental disorders are associated with an increased risk of violence, particularly during acute phases. However, to date a more limited number of studies have been performed to assess the risk of violence in outpatients, particularly in Italy. The present study aims to evaluate the prevalence of violent events in a sample of patients in charge of a community mental health center in Italy. METHODS Based on data obtained from standardized clinical records, a retrospective study was undertaken to investigate acts of violence (physical aggression only) in a total of 678 patients (Males=308, 45.4%) in charge of a university mental health center; patients were mainly affected by anxiety disorders (30.7%), depressive disorder (17.2%), bipolar disorder (18.3%) and schizophrenia or other psychotic disorders (25.0%). RESULTS 27.6% of the sample had committed at least one act of violence during their lifetime, 10.5% over the previous year. 56.7% of those who committed violence acts had acted violently twice or more during their lifetime. A significant association of lifetime violence was found with gender (male), younger age, low education, unemployment, living with parents. With regard to diagnosis, a significant association was found with schizophrenia and other psychotic disorders, personality disorders, mental retardation, and comorbidity between two or more psychiatric disorders. Violence was moreover associated with early age at onset and at first psychiatric treatment, longer duration of the disorder, previous hospital admissions, previous violent events. CONCLUSION Violent behavior is relatively common among outpatients.
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Affiliation(s)
- Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy
| | - Massimo Tusconi
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy
| | - Claudio Dessì
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy
| | - Giuseppe Pittaluga
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, Second University of Naples (SUN), Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy.
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Zwischenmenschliche Gewalt im Kontext affektiver und psychotischer Störungen. DER NERVENARZT 2015; 87:53-68. [DOI: 10.1007/s00115-015-0040-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Gazdag G, Belán E, Szabó FA, Ungvari GS, Czobor P, Baran B. Predictors of suicide attempts after violent offences in schizophrenia spectrum disorders. Psychiatry Res 2015; 230:728-31. [PMID: 26522825 DOI: 10.1016/j.psychres.2015.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 08/11/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023]
Abstract
The aim of this survey was to identify predictors of suicide attempts that immediately followed a violent crime in patients with schizophrenia. Documentations of patients diagnosed with schizophrenia and released in a 10 years period from the National Institute of Forensic Psychiatry were reviewed. Twenty-six out of 223 patients attempted suicide after the violent crime. The young age of the victim, and living in partnership were those factors differentiating suicidal violent offenders from their non-suicidal counterparts.
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Affiliation(s)
- Gábor Gazdag
- Centre for Psychiatry and Addiction Medicine, Szent István and Szent László Hospital, Gyáli út 17-19, 1097 Budapest, Hungary; Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
| | - Emese Belán
- Department of Neurology, Szent Imre Hospital, Budapest, Hungary
| | - Ferenc A Szabó
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gabor S Ungvari
- Notre Dame University Australia, Perth, Australia; School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Pál Czobor
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary; Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Brigitta Baran
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Kjelby E, Sinkeviciute I, Gjestad R, Kroken RA, Løberg EM, Jørgensen HA, Hugdahl K, Johnsen E. Suicidality in schizophrenia spectrum disorders: the relationship to hallucinations and persecutory delusions. Eur Psychiatry 2015; 30:830-6. [PMID: 26443050 DOI: 10.1016/j.eurpsy.2015.07.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Assessment of suicide risk is crucial in schizophrenia and results concerning risk contributed by hallucinations and persecutory delusions are inconsistent. We aimed to determine factors associated with suicidal ideation and plans at the time of acute admission in patients suffering from schizophrenia spectrum disorders. METHODS One hundred and twenty-four patients older than 18 years admitted to an acute psychiatric ward due to psychosis were consecutively included. Predictors of suicidal ideation and suicide plans at the time of admission were examined with multinominal logistic regression and structural equation modelling (SEM). The study design was pragmatic, thus entailing a clinically relevant representation. RESULTS Depression Odds Ratio (OR) 12.9, Drug use OR 4.07, Hallucinations OR 2.55 and Negative symptoms OR 0.88 significantly predicted Suicidal ideation. Suspiciousness/ Persecution did not. Only Depression and Hallucinations significantly predicted Suicide plans. In the SEM-model Anxiety, Depression and Hopelessness connected Suspiciousness/Persecution, Hallucinations and Lack of insight with Suicidal ideation and Suicide plans. CONCLUSIONS The study contributes to an increasing evidence base supporting an association between hallucinations and suicide risk. We want to emphasise the importance of treating depression and hallucinations in psychotic disorders, reducing hopelessness while working with insight and reducing drug abuse in order to lower suicide risk. TRIAL REGISTRATION ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/NCT00932529.
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Affiliation(s)
- E Kjelby
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - I Sinkeviciute
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - R Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - R A Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - E-M Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway
| | - H A Jørgensen
- Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - K Hugdahl
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Norway; NORMENT Centre of Excellence, University of Oslo, Norway
| | - E Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway
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Gallego JA, Rachamallu V, Yuen EY, Fink S, Duque LM, Kane JM. Predictors of suicide attempts in 3.322 patients with affective disorders and schizophrenia spectrum disorders. Psychiatry Res 2015; 228:791-796. [PMID: 26077849 PMCID: PMC4532595 DOI: 10.1016/j.psychres.2015.05.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/31/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
This study explores risk factors for suicide attempts using the electronic health records of 3322 patients with either schizophrenia spectrum disorders or affective disorders who underwent a comprehensive psychiatric evaluation at the Emergency Department at the Long Island Jewish Medical Center or the Hillside Evaluation Center at The Zucker Hillside Hospital from August 3rd 2011 to July 5th 2012. Multivariate regression analyses showed, after adjusting for sex, that previous suicidal attempts and financial or relationship losses were significantly associated with a current suicidal attempt. Additionally, higher odds of having a suicidal attempt were also found in those subjects with a diagnosis of an affective disorder, compared to a schizophrenia spectrum diagnosis, and those patients in the children/adolescent group compared to those in the adult/elderly group. Our study results confirm and expand results from prior studies. Therefore, physicians should be alert for the presence of any or all of these factors upon evaluation of psychiatric patients, and if present, either psychiatric hospitalization or a close psychiatric follow up in collaboration with family and a therapist would be key in reducing the risk of potential suicidal behavior.
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Affiliation(s)
- Juan A. Gallego
- The Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
,The Feinstein Institute for Medical Research, Manhasset, New York, USA
,Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA
| | | | - Eunice Y. Yuen
- State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Sabina Fink
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - John M. Kane
- The Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, New York, USA
,The Feinstein Institute for Medical Research, Manhasset, New York, USA
,Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA
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Castelein S, Liemburg EJ, de Lange JS, van Es FD, Visser E, Aleman A, Bruggeman R, Knegtering H. Suicide in Recent Onset Psychosis Revisited: Significant Reduction of Suicide Rate over the Last Two Decades - A Replication Study of a Dutch Incidence Cohort. PLoS One 2015; 10:e0129263. [PMID: 26068417 PMCID: PMC4466318 DOI: 10.1371/journal.pone.0129263] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/06/2015] [Indexed: 12/24/2022] Open
Abstract
This study aims to compare the suicide risk over the past decade following recent onset psychosis to findings from the eighties and nineties in the same catchment area and to identify predictors of suicide in the context of the Psychosis Recent Onset Groningen-Survey (PROGR-S). A medical file search was carried out to determine the current status of all patients admitted between 2000 and 2009. The suicide rate was compared with a study executed in 1973–1988 in the same catchment area. Predictors of suicide were investigated using Cox regression. The status of 424 of the 614 patients was known in July 2014. Suicide occurred in 2.4% of patients with psychosis disorders (n = 10; mean follow-up 5.6 years); 6 out of 10 suicides took place within two years. Within two decades, the suicide rate dropped from 11% (follow-up 15 years, 8.5% after 5 years) to 2.4%. The Standardized Mortality Rate (SMR) of suicides compared with the general population was 41.6. A higher age was the only significant predictor for suicide. Neuroticism, living situation, disorganized and negative symptoms, and passive coping style all showed a trend for significance. A significant reduction in the suicide rate was found for people with psychosis over the past decades. Given the high SMR, suicide research should be given the highest priority. Identifying predictors may contribute to further reduction of suicide among patients with psychosis.
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Affiliation(s)
- Stynke Castelein
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Edith J. Liemburg
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- NeuroImaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Jill S. de Lange
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank D. van Es
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Center for Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen Visser
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - André Aleman
- NeuroImaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Center for Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henderikus Knegtering
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- NeuroImaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Silverstein SM, Del Pozzo J, Roché M, Boyle D, Miskimen T. Schizophrenia and violence: realities and recommendations. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/23744006.2015.1033154] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Imai A, Hayashi N, Shiina A, Sakikawa N, Igarashi Y. Factors associated with violence among Japanese patients with schizophrenia prior to psychiatric emergency hospitalization: a case-controlled study. Schizophr Res 2014; 160:27-32. [PMID: 25458570 DOI: 10.1016/j.schres.2014.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/09/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Numerous studies have examined a wide range of risk factors associated with violence among patients with schizophrenia. However, risk factors linked to different socio-cultural backgrounds remain unclear. OBJECTIVE The objectives were to investigate factors associated with violence among Japanese patients with schizophrenia prior to emergency hospitalizations and to compare them with factors found in studies on other populations. METHODS We recruited 420 Japanese patients with schizophrenia who had committed violent acts immediately prior to emergency admission to a psychiatric hospital in Tokyo, during the period 1986 to 2005. Cases were compared with controls (non violent hospitalized patients with schizophrenia) matched for gender, age and admission year. All medical records were reviewed retrospectively. Inter-rater reliability tests of assessment were performed. Conditional logistic regression analysis was used to identify factors associated with violence. RESULTS The symptoms of gross excitement, prior violence, auditory hallucinations, systematization of delusions, incoherence of speech, delusions of reference, TCO symptoms, living with others and long duration of illness were found to be associated with violence. In contrast, antisocial traits such as substance abuse and antisocial episodes were not recognized as significant violence-associated factors. CONCLUSION Violence among Japanese patients with schizophrenia was strongly associated with elements of schizophrenia itself, rather than antisocial traits. This study highlighted associated factors for violence among Japanese patients with schizophrenia which differ distinctly from associated factors in other countries. This result demonstrates that future studies assessing the risk of violence among patients with schizophrenia need to consider cultural and racial differences in cohorts.
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Affiliation(s)
- Atsushi Imai
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan; Division of Law and Psychiatry, Center for Forensic Mental Health, Chiba University, Chiba, Japan.
| | - Naoki Hayashi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo Japan
| | - Akihiro Shiina
- Department of Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Noriko Sakikawa
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yoshito Igarashi
- Division of Law and Psychiatry, Center for Forensic Mental Health, Chiba University, Chiba, Japan
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